Manual and Oscillometric Blood Pressure in tPA‐Treated Acute Ischemic Stroke: What Constitutes Agreement?

BACKGROUND Automatic noninvasive oscillometric blood pressure (NIBP) devices measure mean arterial (MAP); systolic and diastolic (SBP, DBP) are algorithmically derived from MAP. The most invalid NIBP is SBP, yet stroke practitioners use it to manage (BP) in accordance with thrombolysis guidelines. We determined agreement between DBP, MAP measured manually by patients treated alteplase. METHODS A multisite prospective observational study of manual BP was conducted alteplase immediately after bolus infusion initiation using methods established guidelines for the assessment device agreement. Dual auscultatory stethoscopes were used 2 investigators ensure each variable calculated standard formula measures. Data analyzed Bland–Altman analyses Lin concordance correlation coefficient. RESULTS total 7 hospitals participated, collecting 5 sets manual/NIBP BPs 95 (475 paired measures). Range limits SBP: −28.91 21.41 mmHg Lin's coefficient 0.8; DBP: −21.0 19.0 0.69; MAP: −27.5 16.5 0.7. There no difference manufacturer brand. Differences sphygmomanometry failed reach guideline recommendations requiring 80% measures fall within a 95% 10 difference. CONCLUSION produce significantly different then auscultated BP. Because rely on do not directly SBP definition what constitutes safe boundaries should be when automatic measurement clinical practice.